Jacob, Desiderio C

Jacob, Desiderio C is an sole proprietor health care provider with primary practice located at 2140 S Santa Fe Ave , Compton CA 90221-5311. He recently has only one registered license in Managed Care Organizations / Preferred Provider Organization, which is considered as his primary health care specialty. Jacob, Desiderio C can be contacted via phone (310) 631-1107.

Contact Information

Primary practice address
2140 S Santa Fe Ave Compton CA 90221-5311
Phone: (310) 631-1107
Fax: (310) 631-6425
Website:
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Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Preferred Provider Organization 305R00000X A23679 California

Profile Details

NPI number 1245456417
LBN Legal business name Jacob, Desiderio C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 17th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245456417 NPPES
California Other A23679 CA MEDICAL LICENSE

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